Send us a text Welcome to today’s episode of AudioBoards — the first episode of our Intern Series, your crash course through the most common hospital conditions. Alcohol withdrawal occurs when a chronic heavy drinker suddenly stops or significantly reduces alcohol intake, and symptoms depend on time since the last drink. Within 6 to 36 hours, patients develop tremors, anxiety, sweating, GI upset, and tongue fasciculations. From 12 to 48 hours, risk increases for withdrawal seizures and alcoholic hallucinosis — visual or tactile hallucinations while oriented. From 48 to 96 hours is the most dangerous phase — Delirium Tremens — with confusion, autonomic instability, tachycardia, hypertension, hyperthermia, and up to 5% mortality. Why does this happen? Think of the brain like a car with two pedals. The brake is GABA — calming. The gas is glutamate — stimulating. Alcohol acts like extra GABA, slamming the brake. With chronic drinking, the brain adapts by removing GABA receptors and increasing glutamate receptors — creating tolerance. When alcohol stops, the brake is weak and the gas pedal is floored: low GABA, high glutamate. The nervous system enters overdrive, causing tremors, anxiety, sweating, tachycardia, hypertension, hallucinations, seizures, and delirium tremens. Severity is measured using the CIWA scale, which guides symptom-triggered treatment rather than fixed dosing. CIWA 15–20: inpatient symptom-triggered benzodiazepines CIWA >20: severe withdrawal requiring intensive monitoring Benzodiazepines are preferred for self-tapering effects. In liver disease, use LOT drugs — lorazepam, oxazepam, temazepam. If inadequate, phenobarbital may be added with ICU-level monitoring. Hospitalized patients receive thiamine, fluids, and nutrition to prevent Wernicke’s encephalopathy. Symptom-triggered dosing is preferred, with front-loading for severe withdrawal (CIWA ≥19). Dosing in chlordiazepoxide equivalents: Mild: 25–50 mg PO Moderate: 50–100 mg PO Severe: 75–100 mg PO Symptom-triggered: 25–100 mg PO every 4–6 hours when CIWA ≥10, with PRN doses. Fixed taper: Day 1 q4–6h Day 2 q6–8h Day 3 q8–12h Day 4 bedtime Optional Day 5 bedtime Front-loading: 50–100 mg PO every 1–2 hours until CIWA 10 or for three doses Phenobarbital: 10 mg/kg IV over 30 minutes or 60–260 mg PO/IM Thanks for listening to AudioBoards. Stay tuned for more educational content in our next episode! The views and opinions expressed on the AudioBoards Podcast do not necessarily reflect those of our employers. This podcast is for educational purposes only and should not be used to diagnose or treat any medical conditions. It is not a substitute for professional medical advice. Always consult a AudioBoards is an audio-learning platform designed to help you review key topics and clinical vignettes while on the move. With the convenience of headphones, you can listen and learn as you go about your day—whether doing household chores, running errands or during your daily workout. This platform lets you make the most of small pockets of time, transforming mundane tasks into valuable learning opportunities. Elevate your internal medicine knowledge without letting a busy schedule hold you back. Try AudioBoards today and enhance your ability to retain important information—one audio lesson at a time. Our goal is to enhance understanding of medical principles while emphasizing that this content is for informational purposes only and not a substitute for professional clinical guidance. Tune in to expand your medical knowledge and stay informed about current trends in medicine!
